Prior Authorization Reform Bill Introduced

Legislation to reform the medication prior authorization was introduced in both the House and Senate on February 2. The bills are chief authored by Rep. Rod Hamilton (R – Mountain Lake) and Sen. Carla Nelson (R – Rochester).

HF 747/SF 593 is a scaled back version of legislation from the last two years designed to ensure patients can get access to needed medications in a timely manner. The bill precludes health plans from forcing a patient to change medications once they have started a therapy during the middle of the patient’s enrollment year, and for all other enrollees they must disclosure to patients, prescribers, and pharmacists and formulary changes at least 60 days prior to the change’s effective date. In addition, the bill requires that any approved prior authorization request remains valid for the duration of the enrollee’s contract term. And finally, the bill requires health plans to disclose to enrollees at least 30 days prior to annual renewal dates additional formulary and cost-sharing information.

A coalition of more than 40 groups support the legislation, including a number of medical specialties and disease advocacy groups, including the National Alliance on Mental Illness (NAMI), the American Heart Association, the National Multiple Sclerosis Society, the Crohn’s & Colitis Foundation of America, and dozens of others. More information on the coalition is available at www.fixpanow.com.

Premium Relief Bill Signed into Law

One of the first bills passed by the Senate and House and signed by Gov. Dayton on January 26 is SF 1. It intended to provide relief for consumers who are facing steep increases in their health insurance premiums. The bill provides a 25% rebate on the cost of premium for those consumers who purchase health insurance in the individual market but are not eligible for federal tax credits.

Also included in the bill is language intended to help protect consumers who may receive “surprise bills” following hospital or surgery center visits or services from a pathology lab that the patient believed to be entirely in-network. In many of these cases, the hospital or surgery center is in-network, but some ancillary services such as radiology or anesthesia were provided by non-network providers. The language of the bill holds patients harmless, and allows negotiation and arbitration between the non-network physician and the health plan over the reimbursement level. The original surprise billing language included in the House version of the bill would have capped the reimbursement for out-of-network physician services at the in-network payment level.

The bill also contains a provision that allows for-profit HMOs to operate in the state. Minnesota had been the only state in the nation to require HMOs to be not-for-profit. In the end Senate conferees rejected a House provision that would have removed all state mandated coverage of conditions and treatments. Requirements that all health plan products cover mental health, maternity care, and cancer screenings along with dozens of other conditions and treatments would have been repealed.

Governor Dayton unveiled his proposed biennial budget late last month, and legislators soon thereafter began the work of more closely studying the $45.8 billion proposal. The budget includes almost $2 billion in new spending compared with the last biennial budget. Legislators will soon begin the work of crafting their own budget proposal in response.

Here are some notable health care items included in the Governor’s budget.

It proposes a new “public option” that would allow all Minnesotans who purchase in the individual insurance market to buy unsubsidized insurance coverage from the state’s MinnesotaCare program, regardless of their income. Gov. Dayton is promoting this to increase the number of options Minnesota have when purchasing through MNsure and he has predicted that the average monthly premium for the public option MinnesotaCare option would be $70 less than the average plan offered by private payers such as Medica or HealthPartners. Critics point out that MinnesotaCare reimbursements to physicians are far less than those from commercial payers and will create significant challenges for clinics to cover their costs.

It includes a shift of more than $700 million in spending from the Health Care Access Fund (HCAF) to pay for the Medical Assistance (MA) program. MA has historically been funded from the General Fund. This is an other example of the HCAF no longer being dedicated for what it was originally intended. If fact, the MA program is now the single largest expenditure from the HCAF.

I proposed extending the state’s 2 percent provider tax beyond the current repeal date of December 31, 2019. While MAFP members are split on the provider tax, many members hope the tax will finally go away.

Interstate Medical Licensure Compact Fixes

A technical statutory correction to the Interstate Medical Licensure Compact quickly cleared its first committee stop in the House on January 31. Authored by Rep. Tony Albright (R - Prior Lake), HF 474 now heads to the House Civil Law Committee for its consideration on February 9.

The original Compact language passed the Legislature unanimously in 2015. The Compact is intended to ease the process of licensure for physicians who wish to practice in multiple states. As the Board of Medical Practice has prepared to begin issuing licenses under the Compact, they were told by the FBI that Minnesota’s law needed a technical correction to allow them to complete the background check process.

This year’s bill passed without controversy and the Senate bill is authored by Sen. Carla Nelson (R - Rochester) and is expected to be heard soon.

Palliative Care Council Created

Legislation to create a state council focused upon raising awareness of palliative care cleared its first hurdle in the Senate when it passed out of the Subcommittee on Aging and Long Term Care on February 1. Authored by Sen. Karin Housley (R – Stillwater), SF 112 establishes the Palliative Care Advisory Committee, a 20 member committee that is to include two physicians, of which one is certified by the American Board of Hospice and Palliative Medicine. Other committee members include nurses, care coordinators, patient advocates, patients and caregivers with experience in chronic diseases, and legislators. The group is tasked with advising state government on matters related to the establishment, maintenance, operation, and outcomes evaluation of palliative care initiatives in the state, as well as making annual reports to the Legislature.

The Senate bill passed the committee and was referred to the Senate State Government Finance and Policy Committee. The House bill is authored by Rep. Nick Zerwas (R – Elk River), and has not yet been scheduled for a hearing.

Text-based Suicide Program Funding Bill Passes First Committee

Continuing work begun in recent legislative sessions, a bill authored by Rep. Kelly Fenton (R - Woodbury) would fund ongoing suicide prevention and mental health crisis response systems. Under the bill, $1.3 million dollars would be earmarked to support nonprofit groups’ voice phone-based suicide prevention services, while an addition $650,000 would be used to support similar text-based services.

The House bill passed the HHS Reform Committee on January 31 and referred to the HHS Finance Committee. There is not yet a Senate companion.

Funding Needed for Family Practice Residency Programs

The University of Minnesota has included additional funding for its Family Medicine and Community Health residency programs in its funding ask to the Legislature. This additional funding is needed with the loss of funding caused by UCare being eliminated from the Medical Assistance program.

Included in their request is $12.5 million for fiscal years 2017-2018 to their family practice residencies. The Family Medicine and Community Health ranks third among National Institutes of Health-funded family medicine departments. This money is clearly needed to ensure future family physicians to serve all Minnesotans, including practicing in our underserved rural and metro communities. The MAFP strongly supports this request.